Template #4

This template was submitted by 🇪🇸 ✝️ CGT ✝️ 🇪🇸 at 5:59 PM, May 20, 2017 and
declined by 🇪🇸 ✝️ CGT ✝️ 🇪🇸 at 6:02 PM, May 20, 2017.